PREMED-24 initial phone consultation

With the PREMED-24 insurance model, if you experience a medical problem you always phone the free medical advice hotline on 0800 773 633 for non-binding advice. If necessary you can make an appointment with a doctor of your choice afterwards.

This allows you to avoid unnecessary visits to the doctor and save 8% on health insurance premiums. The medical benefits are the same as with standard basic insurance.

The free advice hotline will provide you with an initial medical assessment and help you to avoid unnecessary visits to the doctor.

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How the model with an initial phone consultation works

You no longer have to go to a pharmacy or wait a long time for a doctor's appointment if you want medical advice. With the basic health insurance variant PREMED-24 you benefit from independent medical advice by telephone. It is available round the clock, 365 days a year. The advice is completely free, although you may incur connection charges depending on your phone provider's rates.

Initial medical assessment, followed by a visit to the doctor if necessary

You discuss your health problem by phone with a highly qualified healthcare professional. He or she will assess your situation and suggest what you could do.

Regardless of whether it is home treatment, a visit to the doctor or going to hospital, the suggested treatment is a recommendation. You decide on what action you want to take. If necessary, you can then make an appointment with the doctor of your choice.

If a follow-up check or a referral to a specialist or hospital is required after this, you should again contact the medical advice hotline first.

Are there exceptions?

Yes. It is not necessary to call the advice hotline first in the following cases:

Hospital stays

If you have opted for another insurance model, you will receive benefits only subject to the following conditions:

PREMED-24: Before the stay in hospital, you contact the medical advice hotline to receive non-binding health advice.

You receive the costs of a stay in a general ward (multi-bed room) and medical treatment in accordance with the standard rate in your canton of residence.

Choice of hospital

You are free to choose among all the hospitals in Switzerland that are included on the cantonal hospital lists (“listed hospitals”), but receive no more than the costs specified by the tariff of your canton of residence.

Further information

Abroad
EU/EFTA Member States: respective social rate / Other countries: double amount of the insured costs in Switzerland

Emergency treatment abroad (outpatient)

By virtue of the Swiss-EU Bilateral Agreement on the Free Movement of Persons, you have the same access to public healthcare (doctors, pharmacies, hospitals or ambulances) in EU/EFTA countries as the residents of the country you are in at that moment. In the event of a medical emergency you will therefore receive costs in accordance with the basic rate of the country in question.

In all other countries outside Switzerland you will receive the costs for outpatient emergency treatment up to double the amount that the same treatment would cost in Switzerland (rate of your canton of residence).

Emergency treatment abroad (inpatient)

By virtue of the Swiss-EU Bilateral Agreement on the Free Movement of Persons, you have the same access to public healthcare (doctors, pharmacies, hospitals or ambulances) in EU/EFTA countries as the residents of the country you are in at that moment. In the event of a medical emergency you will therefore receive costs in accordance with the basic rate of the country in question.

In all other countries outside Switzerland you will receive the costs for inpatient emergency treatment up to double the amount that the same treatment would cost in Switzerland (rate of your canton of residence).

Transport and rescue
50% up to CHF 500.–

Transport at home

You receive overall 50% of the costs, up to CHF 500 per calendar year, of scheduled transportation to a medical facility for medically necessary treatment at home and abroad.

This is on condition that you choose a recognised mode of transport, e.g. a vehicle operated by Spitex, a wheelchair-accessible taxi, a Red Cross vehicle or an ambulance.

Rescue at home

You can claim 50% of the costs up to CHF 5,000 per calendar year for rescue operations in Switzerland.

Medicines
Medications on the specialities list

You receive the costs of medications prescribed by a doctor which are included on the specialities list.

Special case for points limitation:

Certain medications are divided into therapeutic groups. You receive the costs for a predetermined quantity from this group within 90 days. The doctor or pharmacist is required to inform you of this.

Further information

Outpatient treatment – conventional medicine
According to the tariff in the canton of residence

Outpatient treatment

You receive the costs according to the tariff in your canton of residence for treatment by Federally certified doctors, chiropractors and medical support staff such as physiotherapists, occupational therapists, nurses, midwives, speech therapists, etc.

This is subject to the condition that the treatment has been prescribed by a doctor and is listed in the benefits catalogue of the basic insurance.

Preventive medical care

You receive the costs for specific examinations for the early detection of illnesses and for preventive measures (e.g. vaccinations) that are performed or prescribed by a doctor.

The costs of a gynaecological check-up are covered for women every three years. The costs of mammograms are covered subject to certain conditions. We would be happy to give you information on this by phone.

Medical aids and equipment
According to list

You receive the costs of medically prescribed aids and apparatus, such as crutches, blood-sugar measuring devices, inhalation/respiration therapy equipment and compression stockings, up to the maximum amount specified by law.

This is on condition that the medical aids are listed in the aids and equipment list and that you obtain them from an authorised provider.

Further information

Pregnancy

Check-ups and ultrasound examinations

For a regular pregnancy, you are entitled to seven check-ups carried out by a doctor or six examinations by a midwife.

We will also reimburse you for two ultrasound examinations carried out by a doctor.

For a high-risk pregnancy, you will receive the costs of all necessary check-ups and ultrasound examinations.

Breastfeeding guidance

You receive 3 sessions of breastfeeding guidance from a midwife or specially trained nursing staff. In case of multiple births, you receive up to 2 additional guidance sessions.

Breastfeeding guidance replaces the breastfeeding allowance. This was abolished with the 1996 revision of the Health Insurance Act.

Birth preparation

You can claim CHF 150 per calendar year for ante-natal courses provided by an accredited midwife.

Home birth

For a home birth, you can claim costs in accordance with the applicable rate or contract with the midwife.

Hospital stays

If you have opted for another insurance model, you will receive benefits only subject to the following conditions:

PREMED-24: Before the stay in hospital, you contact the medical advice hotline to receive non-binding health advice.

You receive the costs of a stay in a general ward (multi-bed room) and medical treatment in accordance with the standard rate in your canton of residence.

Nursing care
Cost contribution

Spitex

With home care, the care specialist determines your expected need for care with the direct time requirement. The specialist completes a relevant statement of requirements. We pay for the duration of care required based on the corresponding amount in francs specified by law.

You receive a contribution to the costs for Spitex at home (home nursing care), if prescribed by a doctor.

This is subject to the condition that the chosen Spitex organisation or healthcare professional is qualified and recognised.

Further information

Nursing home

You receive the costs according to the applicable tariff for inpatient care services in a nursing home. The tariff is based on the level of care needed, as determined on your admission.

We cannot assume boarding costs (room and board at the nursing home) from basic insurance.

Spa treatment
CHF 10 per day

You receive CHF 10 per day for up to 21 days per calendar year for spa therapies at recognised therapeutic spas in Switzerland.

Conditions:

The spa treatment is medically certified as necessary.

The spa treatment has been prescribed by a doctor.

The spa treatment is carried out at a recognised therapeutic spa.

FAQs

Answers to frequently asked questions about the PREMED-24 insurance model with an initial phone consultation:

What are the advantages of the insurance model with an initial phone consultation?

An initial medical consultation by phone is available round the clock, 365 days a year.

The advice is completely free for you (depending on your phone provider's rates there may be some connection charges).

You avoid unnecessary visits to the doctor.

The initial medical assessment does not entail any obligation for you – you decide what action you want to take

You receive a discount of 8% on your basic insurance premium with relatively few restrictions.

Can I go to any doctor of my choice?

Yes. After you have received an initial assessment by phone from PREMED-24, you can then make an appointment with a doctor of your choice, if necessary.

However, many health questions can be answered on the phone already, often making a visit to the doctor unnecessary.

What happens if I go directly to a specialist?

By choosing the PREMED-24 advice hotline model, you agree to receive an initial phone consultation for all health problems. If you then still need to see a specialist, you can make an appointment with a doctor of your choice.

If you consult a specialist directly without having called the advice hotline, you are breaching your obligations under this alternative basic insurance model. As a result, Helsana may switch you to the standard model of basic insurance. This will result in you losing the discount on your basic insurance premium associated with the advice hotline model.

Will I be charged for calling the advice hotline?

Calls to the PREMED-24 advice hotline are generally free of charge. Depending on your phone plan, however, there may be some connection charges.

When does the co-payment (annual deductible/excess) apply?

Only when you visit the doctor if you decide to do so after the phone consultation.

Who can take out this insurance model with an initial phone consultation?

Everyone who lives in Switzerland (official place of residence).

Can I switch from standard basic insurance to the advice hotline model?

If you have taken out the mandatory BASIS standard variant with us, you can switch to this alternative insurance model on the first of any month and take advantage of its benefits.

You can terminate the insurance on 31 December of each year and switch to another health insurance company in Switzerland, provided that you have no overdue premiums. There is a one-month notice period from notification of the premium for the following year.

Adults age 19 and over can either select the statutory minimum deductible of CHF 300 or one of five optional deductibles between CHF 500 and CHF 2,500. The higher your deductible, the lower your basic insurance premium.

There is no minimum deductible for children; however, by choosing the optional CHF 500 deductible for them, you can save on their premium too.

Those whose income and assets justify financial support are entitled to a premium reduction (PR). The premium reduction varies from canton to canton and often does not take effect until the policyholder has asked about it. So it is worth asking the competent office of the canton in which you live whether you are entitled to financial support for your health insurance.

Under the Swiss Health Insurance Act (KVG), healthcare insurance is compulsory for anyone living in Switzerland. It provides basic medical care in the event of illness, accidents and maternity, and is therefore known as basic health insurance.

The scope of benefits it covers is regulated by law. This means you receive exactly the same benefits from every health insurer in Switzerland.